I live in Italy & have been taking warfarin for about 9 years and am considered stable so have been transferred to my GP . I usually take 23.75 mg (the tablets are 5mg with a dividing line) a week when in range which is divided between 5 days 3/4 of 5mg tablet & 2 days 1/2 dose. I did ask my GP why I couldn't take 1&1/2 instead of 3/4 for 2 days, he gave me what seemed a very good answer explaining how it worked but as I get older I find it more difficult to cut 3/4 & am seriously thinking of seeing what the difference it makes if any I know everyone will probably say discuss it with your GP but it's not easy to see doctors face to face nowadays & he is the old type of dr (despite not being old) where you go and queue. I would get the anticoagulant machine but have no way of having it checked now and also I think the strips etc might turn out to be a bit too expensive.
Warfarin: I live in Italy & have been... - Atrial Fibrillati...
Warfarin
Hiya paolina,
So, just to make sure I understand things correctly ..... you are only ever supplied with a 5mg Warfarin tablet, which you then cut, using a pill cutter to provide you with daily doses. So, for 5 days a week you cut the 5 mg pill into 3/4 (three quarters or 0.75) which means 5 days you take 3.75 mg = 18.75 .............. then on the other two days you take 2 x 2.5 mg - 5 mg all of which adds up to 23.75 mg per week.
Assuming I got this correct .... then I gotta ask the next obvious question ..... why don't you get your Warfarin in 7.5 mg doses which you then just cut in half and next, get 2.5 mg tablets complete. ... mind you I am not in favour of cutting pills using a pill cutter. I seem to remember reading somewhere against cutting some pills in half or quarters but I can't remember what it was all about.
To the best of my knowledge Warfarin pills come as the following .... 1mg, 2 mg, 2.5mg, 3mg, 4mg, 5mg, 6mg, 7.5mg, and finally 10mg. so, if you must have this weekly dose then you have plenty of ways of achieving it.
Now the other question I must ask ( because I'm not sure I understand) you say "taking warfarin for about 9 years and am considered stable so have been transferred to my GP"
Well, before you were transferred to your GP - who were you with. Maybe an INR clinic ? if so, why don't you leave this GP behind with the dinasaurs and go back to the INR Clinic ? It just seems to me that if your GP doesn't understand Warfarin then you would be better off where you were before.
Sorry to ask these questions, I just wanted to understand more because my next thing was about self testing.
John
Thanks for your reply. You got the dosage correct, in Italy Coumadin comes in 5mg tablets, I did not leave the INR clinic, due to shortage of funds when a person is considered stable they are then transferred to the care of the GP. Self testing would be too expensive. I have just had an INR test so I will see what difference taking one 5mg for 3 days & 1/2 for 3 days - a day missing I'll have to calculate that again 😁!
Aaaaaah, now I get it. I would think that adjusting the dose as you describe is NOT going to make any difference overall to your INR, basically you are saying that you are only gonna drop 1 mg over a period of 7 days. Naaaaah, will make no difference - so long as your diet etc stays CONSISTENT !
Back in 2015 I had a knee replacement done, I had to stop Warfarin. Now I am a bit like you, nice n' stable and was on about 32 mg a week. It took my INR 6 days to drop from my regular INR of about 2.6 down to 0 ( zero) - normal . So what you are gonna do should ( in my humble view) have no impact at all.
John
Thanks, you have confirmed what I thought 😀
Hi paolina,
When you have done what you are planning I would welcome a post from you telling me the result - just outta curiosity.
Thanks.
John
Of course, the next INR test is in 4 - 6 weeks so will let you know. Pauline
Due to being in the middle of changing flat I didn't have the INR blood test till last week, and as we thought my results were still within the range. Thanks for your help.
I also have been taking warfarin for many years. I try to keep my potassium intake fairly constant (that is not too low or too high). To keep an reasonable INR I take 5mg on Tuesday and Friday then 4mg on other days of the week. INR results are in the 2.0-2.5 range.
Previously I had taken just 4mg daily but slowly over months my INR drifted.
Thanks, I am going to try taking 1 1/2 instead of 2 days 3/4 I think as long as the total is 23.75 mg a week there won't be any difference. I'll see next INR test.
Have you considered the new anticoagulants. They are much easier to manage as no testing required except kidney/liver function annually. Or is that not an option?
Yes, I tried rivaroxaban as recommended by my heart specialist. After a week I had a nasty nose bleed so I soon changed back. I'm lucky in that the local chemists do the finger test so control of warfarin is easy. But having said that, I travelled back to the UK for 10 weeks I think it was, and all was OK when I returned to NZ.
Paolina, have you considered one of the new anticoagulants? I changed to Apixaban and no issues.
Yes a few years back (I live in Italy) and I was told they were not prescribed for patients with valvular problems, I don't know if this has changed since then, but at the time when I thought about it I had already decided that I preferred Warfarin as it doesn't matter if you don't take it at the same time and it doesn't matter if you miss one.
Warfarin is cheap. There used to be an agreement so that British pharmacists accepted European prescriptions. Why not find a reputable internet pharmacist who would send you tablets of other sizes?
By the way, I do think it is perfectly practicable to break warfarin tablets into four. I have often done it, using my finger nails, with a few rejects.
I don't have to pay for them. You must have really strong finger nails, my nails would just bend & probably break if I tried that!
Hi there,
Thanks for clearing up that bit about breaking tablets ..... I had read it some where with some drugs it is advised not to break them - but I couldn't remember if it was Warfarin. always good to get some reassurance.
John
There are differences of opinion about breaking tablets. Capsules are another ball game. I am not aware of any quantitative research on breaking tablets. But I use my common sense.1/ Not everyone can do it.
2/ Some pills are difficult, even using tools.
3/ Warfarin tablets are fairly easy, and are scored, making it easier to break in half.
4/ I take it as a matter of trust that the drug is evenly distributed inside the pill.
5/ Crucially, for warfarin, there are a lot of other factors, so it really does not matter if half a one milligram tablet is 0.5, or even 0.3 or 0.7, especially since I use tablet boxes and use the remaining half the next day.
6/ For drugs, there is a zone of therapeutic action, and a little less or a little more does not usually change much.
7/ Your experience may differ. My own experience is using Coaguchek testing to closely self monitor if I am getting it right. Several times I have needed 3.75mg total, so I broke a 3mg tablet into four to give 0.75mg plus another 3mg tablet.
I know another person who successfully broke a different anticoagulant, and needed sizes 1/8, 3/8, and 5/8. It all worked out.
Thanks a lot. Like you I use a tablet box & sometimes the Warfarin is neatly cut & sometimes the quarter gets thrown away as it is so small, which is one of the reasons why I thought 1 on day one and 1/2 on day 2 would be the same as 2 days taking 3/4 - I'll see if there is any significant difference next month! Pauline
One more thing. Twenty years ago a cardiologist explained to me that I must think in terms of the total dose each week, and that I could have five days at one dose and two days, perhaps day 3 and day 7 at another dose. Then he insisted: pick a test day and stick to it.
That worked very well for a few years, until I was able to get better tablet sizes.
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